Skip to main content
Erschienen in: Journal of Gastrointestinal Surgery 11/2010

01.11.2010 | 2010 SSAT Poster Presentation Manuscript

HPB Surgery Can Be Safely Performed in a Community Teaching Hospital

verfasst von: Andrei Cocieru, Pierre F. Saldinger

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 11/2010

Einloggen, um Zugang zu erhalten

Abstract

Introduction

There is ongoing debate about feasibility of performing hepatobiliopancreatic (HPB) cases in low-volume, community hospitals. We decided to analyze outcomes of HPB surgical cases done in our community hospital and compare it with published data from academic centers and/or national data.

Materials and Methods

We reviewed all HPB cases (liver, pancreas, and bile duct cases) performed in an 8-year-period (2001–2009) by HPB-fellowship-trained general surgeon (P.F.S.) at the Danbury Hospital, CT, USA. All electronic files of the patients, who underwent HPB surgery, were reviewed, and all pertinent clinical information was retrieved. Complications and mortality were recorded for length of hospital stay and 30 days after discharge. All complications were graded according to Clavien classification. Pancreatic specific complications—pancreatic fistula/leak and delayed gastric emptying—were graded using International Study Group on Pancreatic Fistula and International Study Group of Pancreatic Surgery definitions.

Results

There were 140 HPB cases. These included 33 pancreatoduodenectomies, 29 distal pancreatectomies, 52 hepatic cases, and 26 cases of other cases involving pancreas and biliary tract. Overall complication rate was 36.4%. Using Clavien classifications, there were 26 grade 1 complications, 21 grade 2 complications, and four grade 3 complications. Two patients underwent reoperation for postoperative complications. Overall mortality was 0.7% (one patient). Pancreas-specific complications included 6% pancreatic leak rate after pancreatoduodenectomy and 24.1% leak rate for distal pancreatectomy.

Conclusion

HPB surgery could be safely performed in community setting, with morbidity and mortality comparable to high-volume centers.
Literatur
1.
Zurück zum Zitat Kingsnorth AN. Major HPB procedures must be undertaken in high volume quaternary centres? HPB Surg 2000;11(5):359–361.CrossRefPubMed Kingsnorth AN. Major HPB procedures must be undertaken in high volume quaternary centres? HPB Surg 2000;11(5):359–361.CrossRefPubMed
2.
Zurück zum Zitat Schell MT, Barcia A, Spitzer AL, Harris HW. Pancreaticoduodenectomy: volume is not associated with outcome within an academic health care system. HPB Surg 2008;2008:825940.CrossRefPubMed Schell MT, Barcia A, Spitzer AL, Harris HW. Pancreaticoduodenectomy: volume is not associated with outcome within an academic health care system. HPB Surg 2008;2008:825940.CrossRefPubMed
3.
Zurück zum Zitat Cunningham JD, O'Donnell N, Starker P. Surgical outcomes following pancreatic resection at a low-volume community hospital: do all patients need to be sent to a regional cancer center? Am J Surg 2009;198(2):227–230.CrossRefPubMed Cunningham JD, O'Donnell N, Starker P. Surgical outcomes following pancreatic resection at a low-volume community hospital: do all patients need to be sent to a regional cancer center? Am J Surg 2009;198(2):227–230.CrossRefPubMed
4.
Zurück zum Zitat Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–196.CrossRefPubMed Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–196.CrossRefPubMed
5.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138(1):8–13.CrossRefPubMed Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138(1):8–13.CrossRefPubMed
6.
Zurück zum Zitat Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142(5):761–768.CrossRefPubMed Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142(5):761–768.CrossRefPubMed
7.
Zurück zum Zitat Kleespies A, Rentsch M, Seeliger H, Albertsmeier M, Jauch KW, Bruns CJ. Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg 2009;96(7):741–750.CrossRefPubMed Kleespies A, Rentsch M, Seeliger H, Albertsmeier M, Jauch KW, Bruns CJ. Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg 2009;96(7):741–750.CrossRefPubMed
8.
Zurück zum Zitat Pitt HA, Kilbane M, Strasberg SM, Pawlik TM, Dixon E, Zyromski NJ, Aloia TA, Henderson JM, Mulvihill SJ. ACS-NSQIP has the potential to create an HPB-NSQIP option. HPB (Oxford) 2009;11(5):405–413. Pitt HA, Kilbane M, Strasberg SM, Pawlik TM, Dixon E, Zyromski NJ, Aloia TA, Henderson JM, Mulvihill SJ. ACS-NSQIP has the potential to create an HPB-NSQIP option. HPB (Oxford) 2009;11(5):405–413.
9.
Zurück zum Zitat Aloia TA, Fahy BN, Fischer CP, Jones SL, Duchini A, Galati J, Gaber AO, Ghobrial RM, Bass BL. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford) 2009;11(6):510–515. Aloia TA, Fahy BN, Fischer CP, Jones SL, Duchini A, Galati J, Gaber AO, Ghobrial RM, Bass BL. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford) 2009;11(6):510–515.
10.
Zurück zum Zitat Urbach DR, Baxter NN. Does it matter what a hospital is "high volume" for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data. BMJ 2004;328(7442):737–740.CrossRefPubMed Urbach DR, Baxter NN. Does it matter what a hospital is "high volume" for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data. BMJ 2004;328(7442):737–740.CrossRefPubMed
11.
Zurück zum Zitat Joseph B, Morton JM, Hernandez-Boussard T, Rubinfeld I, Faraj C, Velanovich V. Relationship between hospital volume, system clinical resources, and mortality in pancreatic resection. J Am Coll Surg 2009;208(4):520–527.CrossRefPubMed Joseph B, Morton JM, Hernandez-Boussard T, Rubinfeld I, Faraj C, Velanovich V. Relationship between hospital volume, system clinical resources, and mortality in pancreatic resection. J Am Coll Surg 2009;208(4):520–527.CrossRefPubMed
12.
Zurück zum Zitat Nathan H, Cameron JL, Choti MA, Schulick RD, Pawlik TM. The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg 2009;208(4):528–538.CrossRefPubMed Nathan H, Cameron JL, Choti MA, Schulick RD, Pawlik TM. The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg 2009;208(4):528–538.CrossRefPubMed
13.
Zurück zum Zitat Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, Rodriguez R, Thayer SP, Fernandez-del Castillo C. Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg 2008;12(10):1691–1697; discussion 1697–8.CrossRefPubMed Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, Rodriguez R, Thayer SP, Fernandez-del Castillo C. Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg 2008;12(10):1691–1697; discussion 1697–8.CrossRefPubMed
14.
Zurück zum Zitat Nathan H, Cameron JL, Goodwin CR, Seth AK, Edil BH, Wolfgang CL, Pawlik TM, Schulick RD, Choti MA. Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg 2009;250(2):277–281.CrossRefPubMed Nathan H, Cameron JL, Goodwin CR, Seth AK, Edil BH, Wolfgang CL, Pawlik TM, Schulick RD, Choti MA. Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg 2009;250(2):277–281.CrossRefPubMed
15.
Zurück zum Zitat Csikesz NG, Simons JP, Tseng JF, Shah SA. Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg 2008;12(9):1534–1539.CrossRefPubMed Csikesz NG, Simons JP, Tseng JF, Shah SA. Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery. J Gastrointest Surg 2008;12(9):1534–1539.CrossRefPubMed
Metadaten
Titel
HPB Surgery Can Be Safely Performed in a Community Teaching Hospital
verfasst von
Andrei Cocieru
Pierre F. Saldinger
Publikationsdatum
01.11.2010
Verlag
Springer-Verlag
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 11/2010
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-010-1215-x

Weitere Artikel der Ausgabe 11/2010

Journal of Gastrointestinal Surgery 11/2010 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.